Trans Accessibility Project: Overview Of Transgender Issues

Human Rights Office: Transgender/Transsexual: Contents: Overview

Trans Accessibility Project:
Overview Of Transgender Issues

This chapter provides an overview of transgender issues, with a focus on transgenderists and transsexuals, particularly female transsexuals. The transgender community is composed of a number of different groups of people with differing cross-gender issues. As with any community, the experiences, needs and politics of groups and individuals vary. In this chapter we outline the general experiences and issues of those in the transgender community. We ask you to keep in mind that they may not reflect the experiences of a particular individual. In addition, there are transgendered people who may not identify with any of the groups or politics outlined below.

The Concept of Gender

Gender commonly refers to a combination of characteristics, expectations and roles that are associated with biological sex. Feminists have rather clearly shown that many aspects of gender are social creations that vary across both time and culture. Feminists have tended to focus on gender presentation (appearance, mannerisms, behaviour) and gender roles (social roles, occupation). The change that is possible in these areas is undeniable: we have seen dramatic change in what is considered appropriate for women and men in the past half century. Prejudice and limitations still exist, but significantly greater freedom of gender expression is evident. For example, women in pants are commonplace and men have greater freedom to adorn themselves (i.e., wear jewelry). The majority of women are now in the paid labour force and it is much more acceptable for a woman to be a police officer, fire fighter or professional athlete. Similarly, it is more acceptable for men to be stay-at-home fathers, nurses, public school teachers or bank tellers than in the past.

But in addition to gender presentation and roles, gender consists of three elements that are often taken for granted: gender identity, biological sex and gender-specific experiences.

[5 Elements of Gender] Gender identity is the self-image or belief that we have about our gender as being female or male. It is assumed to be consistent with our biological sex and it is also assumed to refer to just two genders: male and female. We are generally labelled as female or male at birth by a physician who takes a cursory look at our genitals. If there is a recognizable penis, we are male; if not, we are considered to be female. Most people feel they are the gender that corresponds to the sex assigned at birth. However, this is not true for all people. Gender identity does not always correspond to biological sex. Some people with male biology grow up experiencing themselves as female; and some with female biology feel themselves to be male. Others do not consider their gender to be either female or male, but a blend of both (androgynous); still others feel that they are neither male nor female, but an undefined "third" gender. So, it appears that gender identity exists on a continuum, as does gender expression and gender roles.

In discussions of gender, it has also been assumed that, although gender roles and characteristics can change, people's biological sex is unequivocal: we are born either male or female. However, even this can be debated. Biological sex is determined by chromosomes, hormones, gonads, internal reproductive organs, and external sex and reproductive organs. Although in most people there is consistency among these markers of sex, this is not always the case. Variations among these factors occur in nature and incongruity between markers is more common than most people think. For example, some people are born with both female and male reproductive and sex organs; for others, the sex reflected in their hormones may not be the same as that suggested by chromosomes. We rarely hear of these natural variations, in part, because we live in a society that rigidly adheres to a 2-gender system. When these variations occur, the ambiguity is either surgically or socially erased. In addition to naturally occurring variations in biological sex, medical procedures are now available to alter some aspects of biological sex (e.g., hormones and surgery).

Finally, experiences that are assumed to be gender-specific also contribute to our definition of gender. For example, women's experiences of menstruation, childbirth, or sexual violence are assumed to shape, if not define, our gender; just as are men's experiences of penile erection and aggression. However, there are many women who do not menstruate or have children and who have not been sexually victimized. We do not consider them to be lesser women as a result. Similarly, there are many men who have experienced sexual violence, who are impotent and who have refused to engage in physical aggression. Although these types of experiences are common for women or men, they are not inevitable or necessarily exclusive to that gender.

In summary, our society has been fairly rigid in maintaining a strict 2-gender system, to the exclusion of social and biological variations. However, there is variation within and between the five elements that constitute gender and this is particularly true for transgendered people.

Transgender

Much of the language used in this area is relatively new and will likely continue to evolve for some time. The definitions described here are those most commonly used; however, these terms can be controversial within transgender communities. Therefore, it is important to recognize and respect a transgendered person's right to self-identify and to use language in ways that fit with their own experience and politics.

Currently, "transgender" is the most commonly used term to describe people who cross socially constructed gender boundaries. This term refers to those who do not feel, look, dress or behave in ways that women and men are expected to in our society. The umbrella term "transgendered"includes cross-dressers, intersexuals, transgenderists and transsexuals. Because transgender is used as both an umbrella term and to describe a subgroup (transgenderists), the language can be confusing. As a result, some also use the term "trans-identified" instead of transgender as the inclusive term.

Cross-Dressers

The term "cross-dresser" describes those who wear clothing and accessories typically reserved for those of their "opposite" gender; for example, biological men who wear what we consider to be women's clothing and women who wear traditionally male attire. The term cross-dresser is preferred to the term transvestite. Cross-dressing may be undertaken in particular situations, for specific occasions, or in all aspects of a person's life. It may involve some articles of clothing or full cross-gender clothing and appearance. Some people cross-dress primarily for performance (e.g., drag queens, drag kings, male and female impersonators); however, for others, cross-dressing is a private activity.

The motivation for cross-dressing varies and can include playfulness (i.e., performance), sexual pleasure, or feelings of comfort and relaxation. Some describe feelings of relief when cross-dressed as the pressures associated with their gender role are shed with the clothing. The majority of cross-dressers are heterosexual men. In general, those who identify as cross-dressers may question their gender role or gender expression (how they are "supposed" to appear or act), but not their gender identity. They generally do not want to live as the opposite gender; in other words, most male cross-dressers identify as male, are comfortable being male, and do not want to change that.

Intersexuals

Intersexuals are people who are born with ambiguous sex characteristics. They may have some of the sex and reproductive organs of both sexes or they may have other discrepancies between chromosomal, gonadal or hormonal sex. Intersexed people are often surgically altered at birth or at puberty. A physician decides what sex the child will be based on a number of variables, including the appearance of external genitalia, chromosome markers and potential fertility, among other factors. In most cases surgery is performed to remove the ambiguity and the child is raised as the gender assigned by the physician. The child may be faced with additional surgeries during their physical development, in addition to the ongoing use of hormones.

Some intersexuals feel strong resentment at their lack of choice in determining their own gender and are working to prevent sex reassignment surgery in other infants and children. They may feel comfortable with the sex assigned to them, but angry that they were given no choice about (or even awareness of) what was being done.

Others feel that the wrong choice was made by the physician and have never felt that they were the gender assigned to them. They grow up feeling that, although they were being raised as one gender, they are really the opposite gender. For example, an intersexual who was labelled male at birth may grow up feeling and believing that she was a girl, though raised as a boy. Some intersexuals wish to change their bodies to bring them more in line with their sense of self; that is, undergo hormone or surgical treatment. Others feel that they are neither male, nor female, but a combination of both genders; and still others feel that they are an "undefined" gender and want to be recognized and accepted as such. However, many intersexuals are comfortable with the gender assigned to them and do not have gender identity conflicts.

Transgenderists

People who have a gender identity that does not match their assigned sex often identify as transgenderists (but may identify as transsexuals). The biological sex of transgenderists is usually a source of great distress to them. Transgenderists are generally not comfortable with their bodies and the physical characteristics that do not fit with their identity. For example, a transgendered woman may find her penis humiliating. Her penis, and other markers of male biology, are constant reminders to her that she is in the "wrong" body, and she knows that they determine how others treat her.

Gender identity is thought to develop at an early age (by 2 or 3 years) and is generally not amenable to change. However, there are some transgendered people who report a shift in their gender identity beyond those early years, perhaps as self-awareness increases. Those with cross-gender identities do not necessarily "want" to be the opposite, or another, gender; rather they believe or feel themselves to be so. Gender identity does not appear to be chosen. So, the feelings of embarrassment and injustice that would be experienced by a 10-year old boy who was forced to wear dresses to school are the same as those of a transgendered boy who does not understand why he is being treated like, and is required to act like, a girl. The feelings of a girl who is ridiculed for her small breasts and her boy's haircut are similar to those of a transgendered woman who feels shame about her body's betrayal of her identity. Transgendered men and women can feel that they will never be seen, or accepted, for who they really are.

[Transgenderists] Gender identity is different than sexual orientation (sexual identity). Sexual orientation refers to our emotional and sexual desires for others, whereas gender identity refers to our beliefs about who we are, separate from attractions to others. Transgendered people may be heterosexual, bisexual, lesbian, or gay. However, heterosexual transgenderists (and transsexuals) are often assumed to be same-sex oriented because others do not see, or believe, their gender identity. Therefore, a transgendered woman whose sexual identity is heterosexual will have relationships with men but she may be seen by others as a gay man. A transgendered man who identifies as gay, may be seen by others as a heterosexual woman.

Most transgenderists have an intense desire for consistency between their gender identity, their physical self and their gender role. Most find ways to accommodate their cross-gender identity by adopting enough gender characteristics consistent with their identity to allow them a greater sense of comfort, but without risking the loss of their jobs, their children, partnerships and other social relationships. The degree to which they are able to do so will depend on the nature of their occupations, the nature of their social communities, and acceptance by significant people in their lives.

Some transgenderists assume an androgynous or "gender neutral" presentation as a way of dealing with the internal conflict, thereby blending the characteristics of both genders. This is often easier for transgendered men than for transgendered women as a wider range of dress and gender presentation is generally more permissible for women than for men these days. For example, a transgendered man can wear men's pants and a shirt in most social situations and not be subjected to insults. A transgendered woman may wear more feminine pants and a blouse; however, the extent to which she can express her female gender in this society is limited.

There are also variations in gender rigidity among various communities. A transgendered man is more likely to find acceptance dressing as male, exhibiting traditionally masculine characteristics, and working in a traditionally male occupation within a lesbian community, which challenges traditional gender roles, than within many heterosexual circles. Similarly, a transgendered woman may find greater freedom in dress and expression in a gay male community or in an "alternative" heterosexual community. However, acceptance and support from these alternative communities is far from guaranteed.

In spite of the anticipated loss and hardship, some make the decision to self-identify (come out) as transgendered and adopt a name, occupation, dress and behaviours associated with their gender identity. This move into the life of one's gender identity is referred to as "transitioning" and may include the process of making physical changes through sex reassignment.

Transsexuals

In spite of attempts to live as congruently as possible, most transgenderists struggle their entire lives with the conflict between their physical self and their sense of identity. Some decide to transform their bodies to more closely match their identity and undergo medical sex reassignment. This involves taking hormones, undergoing sex reassignment surgery (SRS), or both. Generally, those who live in their felt gender, and/or choose to bring their physical selves into alignment with their psychological self, identify as transsexuals. However, not all people who identify as transsexuals wish to (or are able to) undertake sex reassignment.

[A transsexual woman may be...] Transsexuals who do desire sex reassignment are referred to gender identity clinics by many physicians and mental health professionals. There are only three gender identity clinics in Canada that we are aware of: in Toronto, Montreal and Vancouver. The purpose of assessment at a gender identity clinic is to determine if the person has a Gender Identity Disorder (a psychiatric classification) and if they are capable of, and committed to, living in the gender of their identity. Patients undergo numerous social, psychological and physiological assessments while being considered for sex reassignment. If they are accepted for the first stage, they are required to transition and live in the gender of their identity, generally for a period of one to two years, prior to hormone therapy or surgical intervention. This is called the Real Life Test and this is a difficult, and often dangerous, period in a transsexual's life.

The Real Life Test requires that a person dress and behave as a member of their felt gender, 24-hours a day, without the benefit of the physical alterations produced by medical intervention. This involves using washrooms, change rooms and public services designed for members of their felt gender. Their ability to withstand the discrimination and "pass" (that is, be considered by others to be a member of their gender) largely determines their acceptance for sex reassignment surgery (SRS).

[Real Life Test] Gender identity clinics are notoriously gender-conservative. During the Real Life Test, transsexuals are coached to "properly" walk, talk, dress and behave according to traditional gender norms. This means that in order to pass the Real Life Test, patients must adopt stereotypically male and female roles and presentations. Many people are critical of the apparent conservatism of many transsexuals, not realizing that a traditional gender presentation is required to gain access to necessary medical procedures. In addition, because some transsexuals are hampered by biological markers of their opposite sex, they may need more numerous and more obvious signals of their gender in order to be recognized for who they are. For example, a biological female with a female identity will have little trouble being seen as a woman by others. She can even play with gender presentation, as many feminists do, without her gender being called into question. She may receive insulting comments from some people, but she will continue to be seen as a woman. A transsexual woman, however, must work harder to have her gender recognized. Significant variations occur in nature among the biological characteristics of males and females (e.g., height, bone structure, muscle mass, breast size); therefore, the transitioning process is more difficult for some than for others.

The decision to undergo hormone therapy or surgery requires weighing the many risks with the benefits of physical changes that reflect one's gender identity. A transsexual woman can expect hormone therapy to soften her skin, reduce the size of her penis and testicles, and change her body shape. Hormones do not raise a transsexual woman's voice or prevent the growth of facial hair. Electrolysis is another expensive and painful procedure that most transsexual women find necessary in order to be "convincing" to others as female. The medical effects (and risks) associated with hormone therapy for transsexuals have not been adequately investigated; for example, little is known about the long-term impact of female hormones on a body producing male hormones. Surgery to reconstruct external genitalia carries even greater risks. It is painful and expensive, is rather undeveloped in technique, carries the risk of permanent damage to muscles, nerves and sexual functioning, and can produce uncertain results in appearance and physical functioning. Clearly, the decision to transition is difficult for any transgendered person and is not undertaken lightly.

In 1998, the government of Ontario announced that it would no longer cover the costs of SRS under OHIP. This further limits the number of people who are able to have surgery as the costs are far beyond the reach of most people. [Approximate Costs of SRS] There are few gender identity clinics available and acceptance for sex reassignment requires that the most intimate aspects of one's life be exposed to a team of professionals. The diagnosis of Gender Identity Disorder must be made to gain access to medical intervention. Many transsexuals are understandably offended at their gender identity being defined as a mental disorder and, given that surgery is no longer covered by OHIP, many see little benefit to being assessed at a gender identity clinic. For all of these reasons, the majority of transsexuals do not go to these clinics. Some physicians and psychiatrists will prescribe hormones based on their own assessment of their patient, without referring them to a clinic. However, some transsexuals who cannot obtain hormones through a physician feel desperate enough to buy them on the street. Those who can afford to pay the fees can arrange for the surgical procedures on their own. However, adding travel and accommodation expenses to surgical fees, means that SRS is now unattainable for all but the most affluent.

Most transsexuals change their name on their licence and other forms of identification when they are transitioning. However, in Ontario, the designated sex on their birth certificate cannot be changed until they are considered to have undergone "irreversible" sex changes (usually hormones and surgery). They are then legally considered to be a person of their new sex and their birth certificate can reflect that change.